Devices, systems, and methods for large tissue specimen removal

ABSTRACT

A system for removal of a tissue specimen from an internal body cavity includes a cannula arrangement having an access cannula including a first elongated tubular member, a deployment cannula including a second elongated tubular member configured for insertion into the first lumen, a deployment plunger including a proximal base and a plurality of engagement arms extending distally from the proximal base, and an inner cannula including a third elongated tubular member. The system further includes a containment bag selectively deployable from the cannula arrangement. Distal advancement of the deployment cannula relative to the access cannula deploys a first portion of the containment bag from the cannula arrangement, and distal advancement of the deployment plunger relative to the deployment cannula and the access cannula deploys a second portion of the containment bag from the cannula arrangement.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. patentapplication Ser. No. 15/867,888, filed on Jan. 11, 2018, which claimsthe benefit of U.S. Provisional Patent Application No. 62/448,266, filedon Jan. 19, 2017; U.S. Provisional Patent Application No. 62/461,488,filed on Feb. 21, 2017; and U.S. Provisional Patent Application No.62/515,622, filed on Jun. 6, 2017. The entire contents of each of theseapplications is hereby incorporated herein by reference.

BACKGROUND Technical Field

The present disclosure relates to tissue specimen removal and, moreparticularly, to devices, systems, and methods facilitating removal of alarge tissue specimen from an internal body cavity, e.g., pelvic cavity.

Background of Related Art

In minimally-invasive surgical procedures, operations are carried outwithin an internal body cavity through small entrance openings in thebody. The entrance openings may be natural passageways of the body ormay be surgically created, for example, by making a small incision intowhich a cannula is inserted.

Minimally-invasive surgical procedures may be used for partial or totalremoval of tissue from an internal body cavity. However, the restrictedaccess provided by minimally-invasive openings (natural passagewaysand/or surgically created openings) presents challenges with respect tomaneuverability and visualization. The restricted access also presentschallenges when large tissue specimens are required to be removed. Assuch, tissue specimens that are deemed too large for intact removal maybe broken down into a plurality of smaller pieces to facilitate removalfrom the internal body cavity.

During such minimally-invasive surgical procedures, it is common that acyst, tumor, or other affected tissue is required to be removed. Inthese and other procedures where cancerous tissue is required to beremoved, removal of the tissue specimen(s) in an enclosed environment ishighly desirable to inhibit seeding of cancer cells. Thus, with respectto breaking down large tissue specimens for removal throughminimally-invasive openings, there is the added challenge of doing sowithin an enclosed environment.

SUMMARY

As used herein, the term “distal” refers to the portion that isdescribed which is further from a user, while the term “proximal” refersto the portion that is being described which is closer to a user.Further, any or all of the aspects described herein, to the extentconsistent, may be used in conjunction with any or all of the otheraspects described herein.

Provided in accordance with aspects of the present disclosure is asystem for removal of a tissue specimen from an internal body cavity.The system includes an access cannula, a deployment cannula, and acontainment bag. The access cannula includes a first elongated tubularmember and defines a lumen extending through the first elongated tubularmember. The deployment cannula includes a second elongated tubularmember and a plurality of engagement arms engaged to the secondelongated tubular member at fixed ends thereof and extending to freeends thereof. The deployment cannula is configured for slidablepositioning within the access cannula and is movable relative there tobetween an initial condition, wherein the engagement arms are disposedwithin the lumen of the access cannula and are retained in positionadjacent the second elongated tubular member, and a deployed condition,wherein the engagement arms are disposed distally of the lumen andextend radially outwardly from the second elongated tubular member. Thecontainment bag includes a plurality of pockets, each pocket configuredto receive one of the engagement arms of the deployment cannula. In theinitial condition, a distal end portion of the containment bag isdisposed within the lumen of the access cannula between the first andsecond elongated tubular members. In the deployed condition, the distalend portion of the containment bag is urged distally from the accesscannula by the engagement arms and biased towards an open configurationby the engagement arms to present a mouth for receipt of a tissuespecimen and/or to urge the mouth about the tissue specimen.

In an aspect of the present disclosure, the access cannula includes aproximal hub disposed at a proximal end of the first elongated tubularmember. In such aspects, the lumen extends through the proximal hub.

In another aspect of the present disclosure, the first elongated tubularmember defines a beveled distal end.

In another aspect of the present disclosure, the deployment cannulaincludes a proximal hub disposed at a proximal end of the secondelongated tubular member.

In yet another aspect of the present disclosure, the deployment cannuladefines a second lumen extending through the second elongated tubularmember.

In still another aspect of the present disclosure, the deploymentcannula is configured as a morcellator.

In another aspect of the present disclosure, the containment bagincludes a reinforced rim at the distal end portion thereof. Thereinforced rim may be resiliently flexible, maintained against its biasin the initial condition, and returned under bias in the deployedcondition.

In yet another aspect of the present disclosure, the containment bagfurther includes a body portion and a proximal end portion. The bodyportion is disposed between the proximal and distal end portions.

In still another aspect of the present disclosure, the containment bagincludes a grasping tab extending from the distal end portion thereof.The distal end portion of the containment bag may be beveled with thegrasping tab extending from a protruding portion of the beveled distalend portion. Additionally or alternatively, the grasping tab may definean aperture therethrough.

In another aspect of the present disclosure, the containment bagincludes a suture arrangement extending from the distal end portionthereof. The suture arrangement, in aspects, may include a plurality ofsutures. The first ends of the sutures may be spaced-apart about andattached to the distal end portion of the containment bag. Additionallyor alternatively, the second ends of the sutures may be attached to oneanother.

In yet another aspect of the present disclosure, the system furtherincludes a second access cannula configured to receive a graspertherethrough to facilitate positioning of a tissue specimen within thecontainment bag.

In still yet another aspect of the present disclosure, the systemincludes a third access cannula configured to receive a surgical cameratherethrough to provide visualization within an internal body cavity.

A method of removing a tissue specimen from an internal body cavityprovided in accordance with the present disclosure includes inserting anaccess cannula through a vagina and into a pelvic cavity, deploying afirst end portion of a containment bag from the access cannula into thepelvic cavity while a second end portion of the containment bag remainsexternal of the pelvic cavity or within the access cannula, positioninga tissue specimen within the containment bag through the first endportion of the containment bag, withdrawing the first end portion of thecontainment bag through an abdominal opening, morcellating the tissuespecimen, tying off the second end portion of the containment bag, andwithdrawing the containment bag through the abdominal opening such thatthe second end portion of the containment bag enters the pelvic cavityvia the vagina and exits the pelvic cavity through the abdominalopening. The containment bag may alternatively be removed through thevagina in the opposite fashion.

In an aspect of the present disclosure, deploying the first end portionof the containment bag includes advancing a deployment cannula throughthe access cannula to urge the first end portion of the containment baginto the pelvic cavity.

In another aspect of the present disclosure, the deployment cannulaincludes a plurality of engagement arms. The engagement arms are biasedoutwardly from an elongated tubular member of the deployment cannulasuch that, upon advancing the deployment cannula through the accesscannula, the engagement arms are outwardly expanded under bias tooutwardly expand the first end portion of the containment bag within thepelvic cavity.

In still another aspect of the present disclosure, the method furtherincludes visualizing at least one of inserting, deploying, positioning,withdrawing, or morcellating through use of a surgical camera insertedthrough another abdominal opening. The another abdominal openingprovides triangulation with the vagina and the abdominal opening.

In another aspect of the present disclosure, morcellating the tissuespecimen includes pulling an RF loop through the tissue specimen to cutthe tissue specimen into smaller strips. A grasper may be used to graspthe tissue specimen to maintain the tissue specimen in position duringmorcellation of the tissue specimen.

In yet another aspect of the present disclosure, positioning the tissuespecimen within the containment bag includes inserting a tenaculumthrough the access cannula and the containment bag, grasping the tissuespecimen, and pulling the tissue specimen through the first end portionof the containment bag into the containment bag and/or advancing thecontainment bag in the opposite direction pushing the containment bagabout the tissue specimen.

In another aspect, a second stage deployment of the containment bag maybe effected where the tissue specimen is located and where morcellationwill occur. This can be done by further advancing the containment bagvia engagement arms and/or a tube inserted through the access cannulaforcing the containment bag further therefrom.

In yet another aspect, a line mid-way on the containment bag may beprovided to indicate how far to pull the containment bag out of theabdominal opening in order to position it ideally with the least amountof pleating for maximized visualization.

In still yet another aspect of the present disclosure, withdrawing thefirst end portion of the containment bag through the abdominal openingincludes inserting a grasper through the abdominal opening, gasping atab at the first end portion of the containment bag, and pulling thefirst end portion of the containment bag out through the abdominalopening. As an alternative to a tab, a pull-string and loop may bedisposed about the first end portion of the tab for similar purposes.

Another system for removal of a tissue specimen from an internal bodycavity provided in accordance with aspects of the present disclosureincludes a cannula arrangement and a containment bag. The cannulaarrangement includes an access cannula, a deployment cannula, adeployment plunger, and an inner cannula. The access cannula includes afirst elongated tubular member defining a first lumen extendingtherethrough. The deployment cannula includes a second elongated tubularmember defining a second lumen extending therethrough and is configuredfor insertion into the first lumen. The second elongated tubular memberdefines a diameter less than a diameter of the first elongate tubularmember such that a first annular spacing is defined between the firstand second elongated tubular members when the second elongated tubularmember is inserted into the first lumen. The deployment plunger includesa proximal base and a plurality of engagement arms extending distallyfrom the proximal base. The plurality of engagement arms are configuredfor insertion through the first annular space. The inner cannulaincludes a third elongated tubular member defining a third lumenextending therethrough and is configured for insertion into the secondlumen. The third elongated tubular member defines a diameter less than adiameter of the second elongate tubular member such that a secondannular spacing is defined between the second and third elongatedtubular members when the third elongated tubular member is inserted intothe second lumen. The containment bag is selectively deployable from thecannula arrangement, whereby: distal advancement of the deploymentcannula relative to the access cannula deploys a first portion of thecontainment bag from the cannula arrangement; and distal advancement ofthe deployment plunger relative to the deployment cannula and the accesscannula deploys a second portion of the containment bag from the cannulaarrangement.

In an aspect of the present disclosure, the first portion of thecontainment bag is disposed within the first lumen.

In another aspect of the present disclosure, the second portion of thecontainment bag is disposed within the first annular space.

In another aspect of the present disclosure, proximal withdrawal andsubsequent distal advancement of the inner cannula relative to thedeployment cannula and the access cannula deploys a third portion of thecontainment bag from the cannula arrangement. In such aspects, the thirdportion of the containment bag may be disposed within the second annularspace.

In still another aspect of the present disclosure, distal advancement ofthe deployment plunger relative to the deployment cannula and the accesscannula urges a portion of each of the engagement fingers distally fromthe deployment cannula and the access cannula. In such aspects, theengagement fingers may be biased towards a radially-outwardly extendingconfiguration such that, upon extension thereof distally from thedeployment cannula and the access cannula, the engagement fingers extendradially-outwardly. Alternatively or additionally, distal end portionsof the engagement fingers may be configured for receipt within pocketsdefined within the containment bag.

In yet another aspect of the present disclosure, the deployment cannulafurther includes a proximal hub defining a central opening communicatingwith the second lumen and a plurality of channels radially-spaced fromthe central opening and configured to receive the plurality ofengagement arms therethrough. The proximal hub of the deployment cannulamay include a base portion and an insert portion releasably engagablewith the base portion. Different insert portions may be interchangeablewith the insert portion.

A method of containing a tissue specimen disposed within an internalbody cavity provided in accordance with the present disclosure includesinserting a cannula arrangement through a vagina and into a pelviccavity. The cannula arrangement includes an access cannula, a deploymentcannula slidably disposed within the access cannula, a deploymentplunger having a plurality of engagement arms slidably disposed within afirst annular space defined between the access cannula and thedeployment cannula, and an inner cannula slidably disposed within thedeployment cannula. A containment bag is disposed within the cannulaarrangement.

The method further includes distally advancing the deployment cannularelative to the access cannula to deploy a first portion of thecontainment bag from the cannula arrangement, in the pelvic cavity, andat least partially about a tissue specimen, and distally advancing thedeployment plunger relative to the deployment cannula and the accesscannula to deploy a second portion of the containment bag from thecannula arrangement and into the pelvic cavity such that the containmentbag is further disposed about the tissue specimen.

In aspects, the method further includes proximally withdrawing the innercannula from the deployment cannula and reinserting the inner cannuladistally through the deployment cannula to deploy a third portion of thecontainment bag from the cannula arrangement and into the pelvic cavity.

In aspects, the method further includes withdrawing the first portion ofthe containment bag from the pelvic cavity through an abdominal port.

In aspects, the method further includes inserting a tenaculum or agrasper through the inner cannula and grasping the specimen with thetenaculum or grasper to maintain the specimen in position or pull thespecimen proximally during deployment of the first and/or secondportions of the containment bag.

In aspects, the method further includes proximally withdrawing the innercannula and inserting a morcellator through the deployment cannula andinto the pelvic cavity within the containment bag. In such aspects, aninsert portion of the deployment cannula is replaced with a differentinsert portion after proximally withdrawing the inner cannula and beforeinserting the morcellator.

Another system for removal of a tissue specimen from an internal bodycavity includes an access cannula defining a lumen extendingtherethrough, a containment bag selectively deployable from the lumen ofthe access cannula and having an open distal end portion, and a suturearrangement extending from the open distal end portion of thecontainment bag.

The suture arrangement may include a plurality of sutures arranged suchthat first ends of the sutures are spaced-apart about and attached tothe distal end portion of the containment bag. The second ends of thesutures are attached to one another.

BRIEF DESCRIPTION OF THE DRAWINGS

The above and other aspects and features of the present disclosure willbecome more apparent in light of the following detailed description whentaken in conjunction with the accompanying drawings wherein likereference numerals identify similar or identical elements and:

FIG. 1 is a side, longitudinal, cross-sectional view of a tissuespecimen removal system provided in accordance with the presentdisclosure, disposed in an initial condition;

FIG. 2 is a side, longitudinal, cross-sectional view of the tissuespecimen removal system of FIG. 1, disposed in a deployed condition;

FIG. 3 is an exploded view of the tissue specimen removal system of FIG.1;

FIG. 4 is a perspective view of a containment bag of the tissue specimenremoval system of FIG. 1;

FIG. 5 is a side, perspective view of an end portion of the containmentbag of FIG. 4 and a deployment cannula of the tissue specimen removalsystem of FIG. 1, illustrating the deployment cannula moving intoengagement with the containment bag;

FIG. 6 is a side, cut-away view of the distal portion of the tissuespecimen removal system of FIG. 1, illustrating the deployment cannulaengaged with the containment bag within the access cannula in theinitial condition of the system;

FIG. 7A is a side, cut-away view of a distal portion of the tissuespecimen removal system of FIG. 1, illustrating one configuration of thecontainment bag collapsed within an access cannula of the tissuespecimen removal system of FIG. 1 in the initial condition of thesystem;

FIG. 7B is a side, cut-away view of the distal portion of the tissuespecimen removal system of FIG. 1, illustrating another configuration ofthe containment bag collapsed within the access cannula in the initialcondition of the system;

FIG. 7C is a side, cut-away view of the distal portion of the tissuespecimen removal system of FIG. 1, illustrating another configuration ofthe containment bag collapsed within the access cannula in the initialcondition of the system;

FIGS. 8A-8H illustrate use of the tissue specimen removal system of FIG.1 for deploying the containment bag about a large tissue specimen withinan internal body cavity, enclosing the large tissue specimen within thecontainment bag, breaking down the large tissue specimen into smallerpieces, and removing the contained pieces from the internal body cavity;

FIGS. 9A-9F are longitudinal, cross-sectional views of another tissuespecimen removal system provided in accordance with the presentdisclosure, illustrating the various positions thereof;

FIGS. 10A-10F illustrate use of the tissue specimen removal system ofFIGS. 9A-9F for deploying a containment bag about a large tissuespecimen within an internal body cavity, enclosing the large tissuespecimen within the containment bag, and breaking down the large tissuespecimen into smaller pieces to enable removal from the internal bodycavity;

FIGS. 11A-11F illustrate another containment bag provided in accordancewith the present disclosure and the use thereof in conjunction with atissue specimen removal system to enclose a tissue specimen thereinwithin an internal body cavity; and

FIG. 12 illustrates a tissue-strip cutting device provided in accordancewith the present disclosure shown in use breaking down a tissue specimeninto smaller tissue strips.

DETAILED DESCRIPTION

The present disclosure provides devices, systems, and methodsfacilitating removal of a large tissue specimen from an internal bodycavity, e.g., pelvic cavity, while maintain the large tissue specimen inan enclosed environment during break down and removal from the internalbody cavity.

Turning to FIGS. 1-3, a system 10 provided in accordance with thepresent disclosure generally includes an access cannula 100, adeployment cannula 200, and a containment bag 300. Access cannula 100includes a proximal hub 110, an elongated tubular sleeve 120, and abeveled distal end portion 130. A lumen 140 extends through proximal hub110 and elongated tubular sleeve 120 to enable the insertion ofdeployment cannula 200, containment bag 300, and, in some embodiments,other surgical instruments, through access cannula 100 and into theinternal body cavity.

Proximal hub 110 of access cannula 100 is configured to remainexternally-disposed and may include an insufflation port (not shown) toenable the introduction of insufflation fluid through lumen 140 and intothe internal body cavity to insufflate the internal body cavity. To thisend, proximal hub 110 may further include one or more seals (not shown)configured to seal lumen 140 in the absence of deployment cannula 200,containment bag 300, and/or other surgical instruments insertedtherethrough, and/or to establish a seal about deployment cannula 200,containment bag 300, and/or other surgical instruments inserted throughlumen 140, in order to maintain the internal body cavity in aninsufflated condition.

Elongated tubular sleeve 120 of access cannula 100 is configured toextend through an access opening an into the internal body cavity suchthat beveled distal end portion 130 is at least partially disposedwithin the internal body cavity, while proximal hub 110 remainsexternally disposed. For example, elongated tubular sleeve 120 may beconfigured to extend through the vagina into the pelvic cavity or, ifthe cervix is still intact, through the vagina and an incision in theposterior vaginal fornix into the pelvic cavity. Beveled distal endportion 130 of access cannula 100 is configured to facilitate atraumaticinsertion of elongated tubular sleeve 120 through an access opening andinto the internal body cavity, although configurations other thanbeveled are also contemplated.

Continuing with reference to FIGS. 1-3 deployment cannula 200 includes aproximal hub 210, an elongated tubular sleeve 220, and a plurality ofengagement fingers 230. A lumen 240 extends through proximal hub 210 andelongated tubular sleeve 220 to enable the insertion of surgicalinstruments through deployment cannula 200 and into the internal bodycavity. Deployment cannula 200 is configured for slidable positioningwithin lumen 140 of access cannula 100 and may be positioned therein inan initial condition (FIG. 1) during manufacturing or may be insertedinto access cannula 100 by a user.

Proximal hub 210 of deployment cannula 200 is configured to remainexternally-disposed relative to the internal surgical site and accesscannula 100. More specifically, in an initial condition (FIG. 1) ofsystem 10, proximal hub 210 is proximally-spaced from proximal hub 110of access cannula 100. In a deployed condition (FIG. 2), on the otherhand, proximal hub 210 is positioned proximally adjacent proximal hub110. Similarly as with proximal hub 110 of access cannula 100, proximalhub 210 of deployment cannula 200 may include one or more seals (notshown) configured to seal lumen 240 in the absence of surgicalinstruments inserted therethrough and/or to establish a seal aboutsurgical instruments inserted through lumen 140, in order to maintainthe internal body cavity in an insufflated condition. Proximal hub 210of deployment cannula 200 may also include an insufflation port (notshown) to enable the introduction of insufflation fluid through lumen240 to, for example, insufflate containment bag 300.

Elongated tubular sleeve 220 of deployment cannula 200 is configured toextend through lumen 140 of access cannula 100 and into the internalbody cavity. More specifically, elongated tubular sleeve 220 defines asuitable length so as to enable proximal hub 210 of deployment cannula200 to remain externally disposed of the internal body cavity and accesscannula 100 while a distal end of elongated tubular sleeve 220 extendsto or beyond beveled distal end portion 130 of access cannula 100.Further, elongated tubular sleeves 220 defines a suitable diameterrelative to that of lumen 140 of access cannula 100 to enablepositioning of elongated tubular sleeve 220 within lumen 140 of accesscannula 100 with engagement fingers 230 and containment bag 300 disposedbetween elongated tubular sleeve 220 of deployment cannula 200 andelongated tubular sleeve 120 of access cannula 100.

Engagement fingers 230 are configured as cantilever springs each havinga fixed end 232 and a free end 234. Although only two engagement fingers230 are illustrated in the drawings, any suitable number of engagementfingers 230 may be provided. Engagement fingers 230 may be formed from aspring-metal, e.g., nitinol, or other suitable material, and arearranged radially-spaced about elongated tubular sleeve 220. Morespecifically, engagement fingers 230 are fixed to the exterior surfaceof elongated tubular sleeve 220 at the fixed ends 232 thereof and extenddistally to free ends 234 thereof. Free ends 234 of engagement fingers230 extend distally beyond the distal end of elongated tubular sleeve220 and are biased radially-outwardly from elongated tubular sleeve 220in the at-rest positions of engagement fingers 230. In the initialcondition of system 10 (see FIG. 1), wherein elongated tubular sleeve220 of deployment cannula 200 is disposed within lumen 140 of accesscannula 100, engagement fingers 230 are retained, against their bias, ina contracted configuration, wherein engagement fingers 230 extendalongside the exterior of elongated tubular sleeve 220, thus enablingengagement fingers 230 and elongated tubular sleeve 220 to fit withinlumen 140 of access cannula 100. Once deployment cannula 200 is advanceddistally relative to access cannula 100 to the deployed condition (FIG.2) of system 10, engagement fingers 230 extend distally from beveleddistal end portion 130 of access cannula 100, thus enabling engagementfingers 230 to return under bias towards their at-rest position, whereinfree ends 234 of engagement fingers 230 are radially-outwardly spacedfrom elongated tubular sleeve 220.

As an alternative to providing deployment cannula 200 with engagementfingers 230, engagement fingers 230 may be disposed on another surgicalinstrument to be used within the internal body cavity such as, forexample, a morcellator (not shown). An exemplary morcellator for thispurpose is described in Patent Application Publication No. US2015/0073429, filed on Jun. 12, 2014, the entire contents of which arehereby incorporated herein by reference.

Referring to FIGS. 3 and 4, containment bag 300 is configured forpositioning, in the initial condition (FIG. 1) of system 10, in theannular space defined between elongated tubular sleeve 120 of accesscannula 100 and elongated tubular sleeve 220 of deployment cannula 200,although a portion of containment bag 300 may extend proximally fromboth access cannula 100 and deployment cannula 200 in the initialcondition (FIG. 1) of system 10. In the deployed condition (FIG. 2) ofsystem 10, containment bag 300 is deployed into the internal body cavityunder urging from deployment cannula 200 and is unfurled, thuspresenting containment bag 300 to enable positioning of a tissuespecimen(s) therein.

Containment bag 300 includes a first open end portion 310, a second openend portion 320, and a body portion 330 disposed between first andsecond open end portions 310, 320, respectively. First and second openend portions 310, 320, respectively, need not be disposed opposite oneanother but can be arranged relative to one another and body portion 330so as to define any suitable configuration such as, for example, adogleg, L-shape, C-shape, or other suitable configuration. Theparticular configuration of containment bag 300 may depend upon thedesired access locations to be used during the tissue specimen removalprocedure. Containment bag 300 may be formed from any suitable material.In particular, containment bag 300 may be formed from a transparent,tear-resistant, stretchable material to enable visualization intocontainment bag 300 from the exterior thereof, inhibit tearing, andfacilitate manipulation of containment bag 300, tissue specimen(s),and/or surgical instrumentation during use.

First open end portion 310 of containment bag 300 defines a generallytubular, elongated configuration of sufficient length to enable firstopen end portion 310 to extend from the internal body cavity, throughaccess cannula 100, to the exterior of the patient. This configurationseparates the interior of containment bag 300 from surrounding patienttissue. First open end portion 310 of containment bag 300 may furtherinclude features (not shown) to facilitate sealed closure thereof suchas, for example, a threaded lip configured to receive a screw-on cap, ormay be configured to be sealed closed by way of a suture, clip,tying-off, or other suitable mechanism or method.

Second open end portion 320 of containment bag 300 likewise defines agenerally tubular, elongated configuration. Second open end portion 320defines a beveled end 321 and is of sufficient length to enable secondopen end portion 320 to extend from the internal body cavity, through asecond access cannula 1100 (FIGS. 8A-8H), different from access cannula100, to the exterior of the patient. Thus, first and second open endportions 310, 320 are capable of extending through access cannulas 100(FIG. 1), 1100 (FIGS. 8A-8H), respectively, while body portion 330 ofcontainment bag 300 is disposed within the internal body cavity. Inaddition or as an alternative to the features of first open end portion310, second open end portion 320 may further include features (notshown) to facilitate sealed closure thereof such as, for example, athreaded lip configured to receive a screw-on cap, or may be configuredto be sealed closed by way of a suture, clip, tying-off, or othersuitable mechanism or method.

With additional reference to FIGS. 5 and 6, second open end portion 320of containment bag 300 further includes a plurality of elongated pockets322 disposed on an interior surface thereof. Elongated pockets 322 arearranged radially-spaced about the interior surface of second open endportion 320 of containment bag 300 and may correspond in number andposition to the number and position of engagement fingers 230 ofdeployment cannula 200 (see FIG. 3). Each elongated pocket 322 defines aproximally-facing open end 324 a configured to receive the free end 234of one of the engagement fingers 230 of deployment cannula 200, and aclosed, distally-facing end 234 b. As such, engagement fingers 230 areconfigured to slide into elongated pockets 322 upon distal insertion ofdeployment cannula 200 into containment bag 300. As an alternative,engagement fingers 230 may be external to containment bag 320 andpockets 322 likewise disposed on the external side thereof.

In the initial condition (FIGS. 1 and 6) of system 10, deploymentcannula 200 extends into containment bag 300 such that engagementfingers 230 are received within elongated pockets 322, with bothdeployment cannula 200 and containment bag 300 disposed within accesscannula 100. In the deployed condition (FIG. 2) of system 10, the biasof engagement fingers 230 towards the radially-outwardly spaced positionrelative to elongated tubular sleeve 220 similarly expands second openend portion 320 of containment bag 300 providing a mouth 326 tofacilitate passage of a tissue specimen into second open end portion 320of containment bag 300.

Referring to FIGS. 3, 4, and 7A-7C, second open end portion 320 ofcontainment bag 300 defines a reinforced rim 327 surrounding the openingthereof. Reinforced rim 327 may be formed from a spring-metal, e.g.,nitinol, or other suitable material that is resiliently flexible,returning to a pre-determined shape in the absence of external forcesapplied thereto. This configuration allows reinforced rim 327 to beflexed or otherwise re-positioned to enable receipt of second open endportion 320 of containment bag 300 within lumen 140 of access cannula100. Upon deployment from lumen 140 of access cannula 100, reinforcedrim 327 returns to its at-rest configuration, thus maintaining mouth 326in an open, expanded position to facilitate passage of a tissue specimeninto second open end portion 320 of containment bag 300. First open endportion 310 of containment bag 300 may likewise define a reinforced rim(not shown) surrounding the opening thereof to facilitate maintainingthe opening of first open end portion 310 in an open conditionexternally of the internal body cavity or, in embodiments, within theinternal body cavity upon deployment from access cannula 100.

With reference to FIG. 7A, in embodiments, reinforced rim 327 may bemanipulated to define an oval-shaped configuration and may be angledrelative to lumen 140 of access cannula 100 to enable reinforced rim 327to fit within lumen 140 of access cannula 100 in the initial conditionof system 10 (FIG. 1). Alternatively, as illustrated in FIG. 7B,reinforced rim 327 may be manipulated to define an oval-shapedconfiguration and then bent to define a distally-facing C-shapedconfiguration to enable reinforced rim 327 to fit within lumen 140 ofaccess cannula 100 in the initial condition of system 10 (FIG. 1). FIG.7C illustrates another alternative, wherein reinforced rim 327 ismanipulated to define an oval-shaped configuration and then bent todefine a proximally-facing C-shaped configuration to enable reinforcedrim 327 to fit within lumen 140 of access cannula 100 in the initialcondition of system 10 (FIG. 1). Other suitable configurations are alsocontemplated.

Referring again to FIGS. 4-6, second open end portion 320 of containmentbag 300 further includes a grasping tab 328 extending from beveled end321 thereof. More specifically, grasping tab 328 extends from thefurther-extended side of beveled end 321 to facilitate grasping of tab328. Tab 328 may further include an aperture 329 configured to receive atooth, hook, or other suitable structure of a grasper “G” (FIG. 8D) tofacilitate grasping of tab 328. As detailed below, the grasping of tab328 enables manipulation of second open end portion 320 of containmentbag 300 within the internal body cavity and/or withdrawal of second openend portion 320 from the internal body cavity.

With reference to FIG. 4, body portion 330 of containment bag 300defines an enlarged diameter relative to first and second open endportions 310, 320, respectively, of containment bag 300 and is disposedtherebetween. Body portion 330 is configured for positioning within theinternal body cavity while either or both of first and second open endportions 310, 320, respectively, extend from the internal body cavity,through an access cannula 100, 1100 (FIGS. 8A-8H), to the exterior ofthe patient. Body portion 330 is configured to receive a tissue specimento be removed and, with the tissue specimen disposed within body portion330, enable breaking down, e.g., via morcellation, of the tissuespecimen into smaller pieces to facilitate removal from the internalbody cavity.

Turning to FIGS. 8A-8H, in conjunction with FIGS. 1-3, the use of system10 in the removal of a large tissue specimen “S” from the pelvic cavity“U,” maintaining the large tissue specimen “S” in an enclosedenvironment during break down and removal, is described. System 10 maybe similarly used in the removal of other tissue specimen from otherinternal body cavities.

Referring initially to FIG. 8A, with system 10 disposed in the initialcondition, access cannula 100, lead by beveled distal end 130 ofelongated tubular sleeve 120, is advanced through the vagina “V” intothe pelvic cavity “U” or, if the cervix is still intact, through thevagina “V” and an incision in the posterior vaginal fornix into thepelvic cavity “U.” In the initial condition of access cannula 100, firstopen end portion 310 of containment bag 300 remains externally of accesscannula 100 and the pelvic cavity “U” or, alternatively, may be disposedwithin access cannula 100 similarly as second open end portion 320 ofcontainment bag 300.

Second and third access cannulas 1100, 2100, respectively, may beinserted through the abdomen into the pelvic cavity “U” to establishtriangulation between the access cannulas 100, 1100, 2100. A surgicalcamera “C” may be inserted through one of the second or third accesscannulas 1100, 2100, e.g., third access cannula 2100, to enablevisualization of the interior of the pelvic cavity “U.”

Next, as illustrated in FIG. 8B, system 10 is transitioned from theinitial condition to the deployed condition to deploy second open endportion 320 of containment bag 300 into the pelvic cavity “U.” Asdetailed above, deployment of containment bag 300 is accomplished bymoving deployment cannula 200 distally through access cannula 100 untilproximal hub 210 of deployment cannula 20 is positioned proximallyadjacent proximal hub 110 of access cannula 100. As a result of thismovement of deployment cannula 200, as also detailed above, engagementfingers 230 are expanded towards the radially-outwardly spaced positionand reinforced rim 327 of second open end portion 320 of containment bag300 is unfurled such that second open end portion 320 of containment bag300 is expanded and mouth 326 presented to facilitate passage of tissuespecimen “S” into second open end portion 320 of containment bag 300.

With reference to FIG. 8C, with second open end portion 320 ofcontainment bag 300 deployed within the pelvic cavity “U,” a tenaculum“T,” or other suitable grasper, may be inserted through lumen 240 ofdeployment cannula 200 and through containment bag 300 to grasp thetissue specimen “S” and pull the tissue specimen “S” through mouth 326and into containment bag 300, as illustrated in FIG. 8D. Visualizationto facilitate positioning of the tissue specimen “S” within containmentbag 300 may be provided via surgical camera “C.” The triangulation ofaccess cannulas 100, 1100, 2100 provides an advantageous point of viewfor surgical camera “C” during the positioning of the tissue specimen“S” within containment bag 300.

Continuing with reference to FIG. 8D, once the tissue specimen “S” ismoved into containment bag 300, grasper “G” may be inserted throughsecond access cannula 1100 to grasp tab 328 of containment bag 300.Under visualization from surgical camera “C,” with grasper “G” graspingtab 328 of containment bag 300, grasper “G” may be retracted backthrough second access cannula 1100 bringing second open end portion 320of containment bag 300 therewith (see also FIG. 8E). Before or afterwithdrawal of second open end portion 320 of containment bag 300, accesscannula 1100 may be removed and re-inserted through second open endportion 320. Alternatively, access cannula 1100 may remain in positionwith second open end portion 320 of containment bag 300 extendingtherethrough. Tenaculum “T” may be maintained in position or moved in anopposite direction to ensure the tissue specimen “S” remains withincontainment bag 300. In either configuration, the triangulation ofaccess cannulas 100, 1100, 2100 provides an advantageous point of viewfor surgical camera “C” during the retrieval of second open end portion320 of containment bag 300 from the pelvic cavity “U.” Further,containment bag 300 may be insufflated at this point, or at any othersuitable juncture, to maximize visualization within containment bag 300.

Referring to FIG. 8E, with containment bag 300 containing the tissuespecimen “S” within body portion 330 thereof and with first and secondopen end portions 310, 320, respectively, extending externally of thepelvic cavity “U,” tenaculum “T” and deployment cannula 200 may beremoved from access cannula 100 in favor of a morcellator “M” that isinserted through first open end portion 310 of containment bag 300 andinto body portion 330 thereof adjacent the tissue specimen “S.”Alternatively, morecellator “M” may be inserted through second open endportion 320 via access cannula 1100 and surgical camera “C” throughfirst end portion 310 via access cannula 100. In embodiments wheremorcellator “M” also serves as the deployment cannula 200, no removal isthus required. In either configuration, with additional reference toFIG. 8F, tenaculum “T” may be used in conjunction with morcellator “M”to break down the tissue specimen “S.” More specifically, as withrespect to the morcellator disclosed in Patent Application PublicationNo. US 2015/0073429, previously incorporated herein by reference, thetissue specimen “S” may be broken down by cutting the tissue specimen“S” into smaller strips “SS.” Other suitable mechanical, electrical, orelectromechanical morcellators, for use with or without tenaculum “T,”are also contemplated.

Surgical camera “C” may be inserted through second access cannula 1100and second open end portion 320 of containment bag 300 to providevisualization within containment bag 300 during morcellation of thetissue specimen “S” or, alternatively, may be disposed through thirdaccess cannula 2100 to enable visualization through containment bag 300,in embodiments where containment bag 300 is transparent.

With reference to FIG. 8G, once tissue specimen “S” is sufficientlybroken down into smaller strips “SS,” morcellator “M” and tenaculum “T”may be removed from access cannula 100 and first open end portion 310 ofcontainment bag 300 sealed off. Alternatively or additionally, secondopen end portion 320 of containment bag 300 may be sealed off. Referringalso to FIG. 8H, containment bag 300 may then withdrawn from the pelviccavity “U” through one of the abdominal openings such that first openend portion 310 is first pulled into pelvic cavity “U” and follows outthrough the abdominal opening, e.g., through one of the access cannulas1100, 2100, or through one of the openings where access cannulas 1100,2100 were disposed. Alternatively, containment bag 300 may be withdrawnthrough the vagina “V” such that second open end portion 320 (which isfirst sealed closed in such embodiments) is first pulled into pelviccavity “U” and follows out through the vagina “V.” In eitherconfiguration containment bag 300 may be removed through one of theaccess cannulas 100, 1100, 2100 or the access cannula(s) 100, 1100, 2100may be removed prior to withdrawal of containment bag 300.

Turning to FIGS. 9A-9F, another system 3010 is provided in accordancewith the present disclosure that facilitates removal of a large tissuespecimen from an internal body cavity while maintaining the large tissuespecimen in an enclosed environment during break down and removal fromthe internal body cavity. System 3010 generally includes an accesscannula 3100, a deployment cannula 3200 slidably receivable withinaccess cannula 3100, a containment bag 3300 (not shown in FIGS. 9A-9F,see FIGS. 10A-10F) selectively deployable from access cannula 3100, adeployment plunger 3400, and an inner cannula 3500.

Access cannula 3100 may be similar to and/or include any of the featuresof access cannula 100 (FIG. 1), detailed above. Access cannula 3100generally includes a proximal hub 3110, an elongated tubular sleeve3120, and defines a lumen 3140 extending therethrough.

Deployment cannula 3200 includes a proximal hub 3210 and an elongatedtubular sleeve 3220 extending distally from proximal hub 3210.Deployment cannula 3200 also defines a lumen 3240 extendingtherethrough. Proximal hub 3210 includes a base 3212 and an insert 3214seated within base 3212. Insert 3214 may be removable from base 3212 andretainable therein via friction-fitting (provided by an O-ring 3216disposed about insert 3214, for example), or may be removably retainablewithin base 3212 in any other suitable fashion. Thus, insert 3214 may bereplaced with a different insert, e.g., insert 3215 (FIG. 9F), having adifferent configuration, depending upon the instrumentation to beinserted therethrough. Alternatively, insert 3214 may be permanentlyseated within base 3212. Insert 3214 defines a central aperture 3218,defining the proximal portion of lumen 3240, that is configured toreceive inner cannula 3500 and/or other instrumentation therethrough.Insert 3214 further defines a plurality of channels 3219 definedtherethrough and positioned radially about central aperture 3218.Channels 3219 are positioned radially outside elongated tubular sleeve3220. As shown, two diametrically opposed channels 3219 are definedthrough insert 3214. However, any suitable number and/or positioning ofchannels 3129 may be provided.

Elongated tubular sleeve 3220 of deployment cannula 3200, as notedabove, extends distally from proximal hub 3210. Elongated tubular sleeve3220 of deployment cannula 3200 defines a reduced diameter as comparedto elongated tubular sleeve 3120 of access cannula 3100 so as to definean annular spacing 3222 therebetween when deployment cannula 3200 isreceived within access cannula 3100. Further, with deployment cannula3200 received within access cannula 3100, channels 3219 of insert 3214are aligned and communicate with annular spacing 3222. Elongated tubularsleeve 3220 defines a length sufficiently greater than that of elongatedtubular sleeve 3120 of access cannula 3100 such that, with deploymentcannula 3200 fully received within access cannula 3100, elongatedtubular sleeve 3220 extends distally from elongated tubular sleeve 3120.

Deployment plunger 3400 includes a proximal base 3410 and a plurality ofengagement fingers 3430 extending therefrom. Although only twodiametrically opposed engagement fingers 3430 are illustrated in thedrawings, any suitable number of engagement fingers 3430 may beprovided, and may correspond to the number and positioning of channels3219 of insert 3214 to enable slidable positioning of fingers 3430through channels 3219 and into annular spacing 3222 defined betweenelongated tubular sleeve 3220 of deployment cannula 3200 and elongatedtubular sleeve 3120 of access cannula 3100. Engagement fingers 3430 areconfigured as cantilever springs biased radially-outwardly in theat-rest positions thereof. However, when received within channels 3219and/or annular spacing 3222, engagement fingers 3430 are retained in asubstantially linear configuration against the bias thereof. Engagementfingers may further be configured similar to engagement fingers 230,detailed above (FIG. 3.)

Inner cannula 3500 includes a proximal hub 3510 and an elongated tubularsleeve 3520 extending distally from proximal hub 3510. Inner cannula3500 also defines a lumen 3540 extending therethrough. Proximal hub 3510is configured for insertion at least partially into central aperture3218 of insert 3214 of deployment cannula 3200 and may be releasablyretainable therein via friction-fitting (provided by an O-ring 3512disposed about proximal hub 3510, for example). Proximal hub 3510further defines a central opening 3518, defining the proximal end oflumen 3540, that is configured to receive instrumentation therethrough.

Elongated tubular sleeve 3520 of inner cannula 3500, as noted above,extends distally from proximal hub 3510. Elongated tubular sleeve 3520of inner cannula 3500 defines a reduced diameter as compared toelongated tubular sleeve 3220 of deployment cannula 3200 so as to definean annular spacing 3522 therebetween when inner cannula 3500 is receivedwithin deployment cannula 3200. Further, elongated tubular sleeve 3520defines a length sufficiently greater than that of elongated tubularsleeve 3220 of deployment cannula 3200 such that, with proximal hub 3510fully seated within central aperture 3218 of insert 3214 of deploymentcannula 3200, elongated tubular sleeve 3520 extends further distallythan elongated tubular sleeve 3220. As such, with inner cannula 3500fully received within deployment cannula 3200 and with deploymentcannula 3200 fully received within access cannula 3100, elongatedtubular sleeve 3520 also extends distally from elongated tubular sleeve3120.

With additional reference to FIGS. 10A-10F, containment bag 3300 may beconfigured similar to containment bag 300 (FIGS. 3-7C), detailed above,and may include any or all of the features thereof. Containment bag3330, similar to containment bag 300 (FIGS. 3-7C), is configured forpositioning, in an initial condition of system 3010, within accesscannula 3100, and is deployable therefrom to a deployed condition ofsystem 3010, wherein containment bag 3300 is deployed into the internalbody cavity under urging from deployment cannula 3200, deploymentplunger 3400, and inner cannula 3500, and is unfurled, thus presentingcontainment bag 3300 to enable positioning of a tissue specimen therein.Containment bag 3330 may be fully deployed into the internal bodycavity, or a portion of containment bag 3300 may extend proximally fromaccess cannula 3100 and remain externally thereof, similarly as detailedabove with respect to containment bag 300 (FIGS. 8A-8H). Alternatively,one end portion of containment bag 3300 may be attached (removably orpermanently) to one of the components of system 3010, e.g., accesscannula 3100, deployment cannula 3200, or inner cannula 3500. Likewise,in other embodiments, rather than being externalized, one end portion ofthe containment bag may be attached to one of the components of thedeployment system thereof. Such a configuration allows for access ofdifferent devices (e.g., tenaculum, grasper, morcellator, etc.) into thespecimen bag while maintaining pneumoperitoneum, and also helps controlthe excess bag material and improve usability. Further, as detailedbelow, containment bag 3300 may be deployed into the internal bodycavity in two or more stages, although a single, continuous deploymentis also contemplated.

In the initial condition of system 3010, a distal portion of containmentbag 3300 (including the furled, reinforced rim thereof), is maintainedwithin lumen 3140 of access cannula 3100 distally of deployment cannula3200; an intermediate portion of containment bag 3300 is disposed withinannular spacing 3222 defined between elongated tubular sleeve 3220 ofdeployment cannula 3200 and elongated tubular sleeve 3120 of accesscannula 3100; and a proximal portion of containment bag 3300 is disposedwithin annular spacing 3522 defined between elongated tubular sleeve3520 of inner cannula 3500 and elongated tubular sleeve 3220 ofdeployment cannula 3200, although part of the proximal portion may alsoextend proximally from deployment cannula 3200 and remain externally,similarly as detailed above with respect to system 10 (FIGS. 8A-8H).Other configurations for containment bag 3300, in the initial conditionof system 3010, are also contemplated.

Deployment of containment bag 3300 from the above-noted initialcondition of system 3010 to the deployed condition thereof, as detailedbelow, is effected in a plurality of stages: initially by distaladvancement of deployment cannula 3200 relative to access cannula 3100to deploy the distal portion of containment bag 3300; further via distaladvancement of deployment plunger 3400 relative to deployment cannula3200 and access cannula 3100 to deploy the intermediate portion ofcontainment bag 3300; and, finally, by withdrawal and re-insertion ofaccess cannula 3500 to and from deployment cannula 3200, to deploy someor all of the proximal portion of containment bag 3300.

Referring to FIGS. 10A-10F, in conjunction with FIGS. 9A-9F, the use ofsystem 3010 in the removal of a large tissue specimen “S” from thepelvic cavity “U,” maintaining the large tissue specimen “S” in anenclosed environment during break down and removal, is described. System3010 may be similarly used in the removal of other tissue specimen fromother internal body cavities. Further, use of system 3010 and additionalinstrumentation used therewith, e.g., abdominal ports, surgical cameras,graspers, etc., are similar to that detailed above with respect tosystem 10 (FIGS. 8A-8H) and, thus, only differences will be detailedbelow while similarities are summarily described or omitted entirely forpurposes of brevity.

Referring initially to FIGS. 9A and 10A, with system 3010 disposed inthe initial condition, access cannula 3100 is advanced through thevagina “V” into the pelvic cavity “U” or, if the cervix is still intact,through the vagina “V” and an incision in the posterior vaginal fornixinto the pelvic cavity “U.” Next, as illustrated in FIGS. 9B and 10B,system 3010 is transitioned from the initial condition to apartially-deployed condition to deploy the distal portion of containmentbag 3300 into the pelvic cavity “U.” This partial deployment isaccomplished by moving deployment cannula 3200, together with deploymentplunger 3400, distally relative to access cannula 3100 until proximalhub 3210 of deployment cannula 3200 is positioned proximally adjacentproximal hub 3110 of access cannula 3100. Although deployment plunger3400 is moved distally, it remains fixed relative to deployment cannula3200, whereby proximal base 3410 of deployment plunger 3400 isproximally-spaced from proximal hub 3210 of deployment cannula 3200. Asa result of the above-detailed movement of deployment cannula 3200 anddeployment plunger 3400, the distal end of deployment cannula 3200 urgesthe distal portion of containment bag 3300 distally from lumen 3140 ofaccess cannula 3100 and into the pelvic cavity “U.” In addition,engagement fingers 3430 of deployment plunger 3400 are partiallyextended into the pelvic cavity “U” to facilitate deployment ofcontainment bag 3300. However, the majority of containment bag 3330remains disposed within access cannula 3100.

With reference to FIGS. 9C and 10C, in order to further deploycontainment bag 3300 about tissue specimen “S,” a tenaculum “T” isinserted through inner cannula 3500 and into the pelvic cavity “U” tograsp the tissue specimen “S” and either maintain the tissue specimen“S” in position or pull the tissue specimen “S” towards access cannula3100. With the tenaculum “T” grasping the tissue specimen “S,”deployment plunger 3400 is advanced distally relative to access cannula3100 and deployment cannula 3200 such that engagement arms 3420 areadvanced distally through channels 3219, annular spacing 3222, andfurther into the pelvic cavity “U” to urge containment bag 3300 distallyfrom access cannula 3100 further into the pelvic cavity “U” and aboutthe tissue specimen “S.” Engagement arms 3420 may be configured toengage containment bag 3300 similarly as detailed above with respect tosystem 10 (FIGS. 8A-8H) to facilitate deployment thereof, or may beconfigured to deploy containment bag 3300 in any other suitable fashion.

Referring also to FIGS. 9D, 9E, 10D, and 10E, in order to completedeployment of containment bag 3300, deployment plunger 3400 is retractedproximally back to its initial position, or removed entirely. Inaddition, inner cannula 3500 is momentarily withdrawn proximally fromdeployment cannula 3200, allowing the portion of containment bag 3300disposed within annular spacing 3322 to collapse into lumen 3240 ofdeployment cannula 3200 and occupy more space thereof. Inner cannula3500 may then be re-inserted into deployment cannula 3200 to urge therepositioned portion of containment bag 3300 distally therefrom and intothe pelvic cavity “U.”

Prior to or after withdrawal and re-insertion of inner cannula 3500, thedistal portion of containment bag 3300 may be withdrawn through anabdominal port, similarly as detailed above with respect to system 10(FIGS. 8A-8H).

Next, as shown in FIGS. 9F and 10F, inner cannula 3500 may once again beremoved, along with deployment plunger 3400 (if not removed already). Ifnecessary, insert 3214 may be replaced with a different insert 3215having a different, e.g., larger, internal diameter, and a morcellator“M” inserted through insert 3215 and through deployment cannula 3200into the pelvic cavity “U.” Of course, if replacement is not required,e.g., if a larger diameter is not needed, insert 3214 may be utilized.Insufflation of containment bag 3300 may also be accomplished at thispoint, if required. Once morcellator “M” is inserted into position,tenaculum “T” may be inserted through morcellator “M” to grasp and/ormanipulate the tissue specimen “S” during morcellation. Completion ofmorcellation and removal of the containment bag 3300 with the tissuespecimen “S” therein may be accomplished similarly as detailed abovewith regard to system 10 (FIGS. 8A-8H). Further, similarly as detailedabove with regard to system 10 (FIGS. 8A-8H), some or all of the abovemay be performed under observation using a surgical camera inserted froman abdominal port.

Turning to FIGS. 11A-11F, another containment bag provided in accordancewith the present disclosure is shown generally identified by referencenumeral 4300. Containment bag 4300 may be similar to and include any orall of the features of containment bag 300 (FIGS. 4-6) except that,rather than a grasping tab 328 (FIGS. 4-6) to facilitate manipulation ofthe second open end portion within an internal body cavity, insertion ofa tissue specimen through the second open end portion, and/or withdrawalof the second open end portion from the internal body cavity,containment bag 4300 includes a suture arrangement 4330. Containment bag4300 may be utilized in conjunction with any or all of the devices,systems, and methods detailed above.

Suture arrangement 4330 includes a plurality of sutures, e.g., first,second, and third sutures 4332, 4334, 4336, respectively. However,although three (3) sutures 4332, 4334, 4336 are illustrated anddescribed herein, any suitable number of sutures may be provided.Sutures 4332, 4334, 4336 are attached at first ends thereof to secondopen end portion 4320 of containment bag 4300 about the annularperiphery thereof. More specifically, sutures 4332, 4334, 4336 arespaced-apart about at least a portion of the annular periphery of secondopen end portion 4320 of containment bag 4300. In embodiments, the firstends of sutures 4332, 4334, 4336 are equally-spaced about at least aportion of the annular periphery of second open end portion 4320 ofcontainment bag 4300. However, sutures 4332, 4334, 4336 need not beequally-spaced, nor do sutures 4332, 4334, 4336 need to extend about theentire annular periphery of second open end portion 4320 of containmentbag 4300. Rather, the first ends of sutures 4332, 4334, 4336 may bedisposed in any suitable configuration to facilitate manipulation ofsecond open end portion 4320 of containment bag 4300, insertion of atissue specimen “S” through the second open end portion 4320 and intocontainment bag 4300, and/or withdrawal of second open end portion 4320from an internal body cavity, e.g., the pelvic cavity “U.”

The second ends of sutures 4332, 4334, 4336 may be joined to one anothervia knotting or in any other suitable manner or via any other suitablemechanism such as, for example, using a cuff 4338 (FIG. 11A).Alternatively, the second ends of sutures 4332, 4334, 4336 may remainunattached. In embodiments where the second ends of sutures 4332, 4334,4336 are attached, and as detailed below, the second ends of sutures4332, 4334, 4336 may collectively be withdrawn from the pelvic cavity“U” through a single access cannula, e.g., additional access cannula5200. In embodiments where the second ends of sutures 4332, 4334, 4336remain unattached, on the other hand, the second ends of two or more ofthe sutures 4332, 4334, 4336 may be withdrawn from the pelvic cavity “U”through different access cannulas, although they may also be withdrawnthrough the same access cannula.

In embodiments, additional sutures (not shown) may be attached to one ormore of sutures 4332, 4334, 4336 towards either end thereof, at eitherend thereof, or at an intermediate portion thereof. The additionalsutures (not shown), for example, may extend between and interconnectintermediate portions of sutures 4332, 4334, 4336, or may extend fromone or more of sutures 4332, 4334, 4336 with the second ends thereofjoined with the second ends of sutures 4332, 4334, 4336. Other suitableconfigurations are also contemplated.

Suture arrangement 4330 provides triangulation about second open endportion 4320 of containment bag 4300. This triangulation, morespecifically, allows sutures 4332, 4334, 4336 to be grasped andmanipulated to maneuver second open end portion 4320 of containment bag4300 within the pelvic cavity “U” while maintaining second open endportion 4320 of containment bag 4300 in proper orientation to accept thetissue specimen “S” therethrough. This triangulation also facilitatesadvancement of second open end portion 4320 of containment bag 4300about the tissue specimen “S” via manipulating sutures 4332, 4334, 4336,and, ultimately, withdrawal of sutures 4332, 4334, 4336 and second openend portion 4320 of containment bag 4300 from the pelvic cavity “U.”

In use, with reference to FIG. 11A, containment bag 4300 is initiallydisposed within a cannula 5100 (which may be the cannula of any of thesystems disclosed hereinabove or any other suitable cannula or cannulasystem) in an initial condition and cannula 5100 is advanced through thevagina “V” into the pelvic cavity “U” or, if the cervix is still intact,through the vagina “V” and an incision in the posterior vaginal fornixinto the pelvic cavity “U.” One or more access cannulas 5200 may beinserted through the abdomen into the pelvic cavity “U,” prior to orafter insertion of cannula 5100.

With additional reference to FIG. 11B, one or more graspers “G” may beinserted through the one or more additional access cannulas 5200 andmanipulated to grasp the second ends of sutures 4332, 4334, 4336(collectively or independently) of suture arrangement 4330. Morespecifically, in embodiments where the second ends of sutures 4332,4334, 4336 are attached to one another, e.g., via cuff 4338, one grasper“G” may be utilized to grasp cuff 4338 and pull cuff 4338 through thepelvic cavity “U” towards additional access cannula 5200. In thismanner, second open end portion 4320 of containment bag 4300 is deployedfrom cannula 5100 and into the pelvic cavity “U.”

Referring to FIGS. 11C-11E, with second open end portion 4320 ofcontainment bag 4300 deployed within the pelvic cavity “U,” a tenaculum“T,” or other suitable grasper, may be inserted through cannula 5100 andthrough containment bag 4300 to grasp the tissue specimen “S.” With thetenaculum “T” grasping the tissue specimen “S” to maintain the tissuespecimen “S” stationary or drawing the tissue specimen “S” proximallytowards cannula 5100, the second ends of sutures 4332, 4334, 4336 arepulled in a generally opposing direction such that second open endportion 4320 of containment bag 4300 is likewise pulled in the generallyopposing direction, e.g., towards additional access cannula 5200. Asdetailed above, the triangulation provided by suture arrangement 4330helps ensure that second open end portion 4320 of containment bag 4300is maintained in an open condition and oriented towards the tissuespecimen “S” as it is pulled towards about the tissue specimen “S” suchthat the tissue specimen “S” is received within second open end portion4320 of containment bag 4300. Ultimately, the second ends of sutures4332, 4334, 4336 are pulled out of the pelvic cavity “U” throughadditional access cannula 5200.

With additional reference to FIG. 11F, the second ends of sutures 4332,4334, 4336 are withdrawn through additional access cannula 5200sufficiently such that sutures 4332, 4334, 4336 and second open endportion 4320 of containment bag 4300 are likewise pulled out of thepelvic cavity “U” through additional access cannula 5200, leaving thetissue specimen “S” disposed within containment bag 4300 within thepelvic cavity “U” with the first open end portion of containment bag4300 and second open end portion 4320 thereof extending throughdifferent cannulas 5100, 5200 externally of the pelvic cavity “U.” Theabove-detailed use of containment bag 4300 may otherwise be similar toand include any of the features of the above-described devices, systems,and methods. For example, the tissue specimen “S” may be broken down bycutting the tissue specimen “S” into smaller strips “SS” (FIGS. 8F-8H)to facilitate removal from the pelvic cavity “U,” the first open endportion of containment bag 4300 may be sealed off, and containment bag4300 may be withdrawn from the pelvic cavity “U” through additionalaccess cannula 5200.

Turning now to FIG. 12, as mentioned above, the tissue specimen “S” maybe broken down by cutting the tissue specimen “S” into smaller strips“SS” to facilitate removal from the pelvic cavity “U.” A tissue-stripcutting device provided in accordance with the present disclosure andsuitable for the purpose is detailed below and generally identified byreference numeral 6000. Tissue-strip cutting device 6000 is not limitedfor use with the devices, systems, and methods detailed herein but,rather, may be used with various other devices, systems, and methods tocut a tissue specimen “S” into smaller strips “SS.” Similarly, theabove-detailed devices, systems, and methods need not employtissue-strip cutting device 600 but may utilize any other suitabledevice(s) for cutting the tissue specimen “S” into smaller strips “SS.”

Tissue-strip cutting device 6000 includes an elongated tubular member6100, a grasper 6200, and a cutting element 6300. Elongated tubularmember 6100, grasper 6200, and cutting element 6300 may be coupled toone another as part of an integral device or may be separate from oneanother. Elongated tubular member 6100 may be insertable through anaccess cannula, e.g., through access cannula 100 and into containmentbag 300 (FIGS. 8E-8F), or may be an access cannula itself. In eitherconfiguration, elongated tubular member 6100 defines a lumen 6110extending longitudinally therethrough.

Grasper 6200 is configured to extend through lumen 6110 of elongatedtubular member 6100 and distally therefrom such that working end 6210 ofgrasper 6200 may extend into an internal surgical site, e.g., intocontainment bag 300 disposed within the pelvic cavity “U” (see FIGS.8E-8F), for positioning adjacent the tissue specimen “S” to be cut intosmaller strips “SS.” Grasper 6200 is configured to grasp a portion ofthe tissue specimen “S” to maintain the tissue specimen “S” insubstantially fixed position relative to grasper 6200 and elongatedtubular member 6100. Working end 6210 may include a pair of pivotablejaw members 6220, or any other suitable component(s), that enablegrasping of the tissue specimen “S” therewith.

Cutting element 6300 includes a pair of elongated, spaced-apart rods6310 interconnected at their respective distal ends via a U-shaped loop6320 that depends from rods 6310. Rods 6310 are formed at leastpartially from an electrically-conductive material and may be coveredwith an insulative coating or sheath (not shown). U-shaped loop 6320 islikewise formed from an electrically-conductive material and may beintegral with or engaged and electrically coupled to rods 6310. Eitheror both of rods 6310 is adapted to connect to a source ofelectrosurgical energy, e.g., RF energy, to enable the selectiveenergization of U-shaped loop 6320. U-shaped loop 6320 may function as amonopolar electrode for use with a remote return pad (not shown), or mayfunction as one electrode in a bipolar configuration, with anothercomponent, e.g., a portion of grasper 6200, a portion of elongatedtubular member 6100, or other suitable component, severing as the otherelectrode.

Cutting element 6300 is configured to extend through lumen 6110 ofelongated tubular member 6100 and distally therefrom. More specifically,cutting element 6300 is selectively translatable through and relative toelongated tubular member 6100 between a distal position (illustrated inphantom in FIG. 12), wherein U-shaped loop 6320 is further-spaceddistally from elongated tubular member 6100, and a proximal position(illustrated in FIG. 12), wherein U-shaped loop 6320 is closer toelongated tubular member 6100. As detailed below, movement of cuttingelement 6300 from the distal position to the proximal position whileenergy is supplied to U-shaped loop 6320 serves to cut an elongatedstrip “SS” of tissue from tissue specimen “S.”

Continuing with reference to FIG. 12, in use, elongated tubular member6100 is inserted through an access cannula or directly into the internalsurgical site adjacent the tissue specimen “S” to be broken down andremoved. As noted above, in embodiments, elongated tubular member 6100may be inserted into a containment bag, e.g., containment bag 300 (FIG.8E), disposed within the internal surgical site and containing thetissue specimen “S” to be broken down and removed therein.

With elongated tubular member 6100 inserted as detailed above, grasper6200 may be manipulated to grasp the tissue specimen “S” with workingend 6210 thereof to thereby maintain the tissue specimen “S”substantially stationary relative to elongated tubular member 6100 andgrasper 6200.

With the tissue specimen “S” retained in position, cutting element 6300,if not done so already, may be advanced distally to the distal positionand tissue-strip cutting device 6000 manipulated such that a portion ofthe tissue specimen “S” is disposed between U-shaped loop 6320 ofcutting element 6300 and the distal end of elongated tubular member6100. Once cutting element 6300 has reached the distal position (or asufficiently-distal position such that a portion of the tissue specimen“S” is disposed between U-shaped loop 6320 and elongated tubular member6100), cutting element 6300 is energized and translated proximallyrelative to elongated tubular member 6100, grasper 6200, and, thus, thetissue specimen “S.” As a result, a smaller tissue strip “SS” iselectromechanically cut from the tissue specimen “S.”

The above-detailed cutting of smaller tissue strips “SS” from the tissuespecimen “S” may be repeated until the remaining portion of the tissuespecimen “S” is sufficiently small so as to allow for minimally-invasiveremoval. The smaller tissue strips “SS” may be removed, one or more at atime, through elongated tubular member 6100, e.g., using grasper 6200,or may be removed together with the containment bag 300 (FIGS. 8E-8H).

From the foregoing and with reference to the various drawings, thoseskilled in the art will appreciate that certain modifications can bemade to the present disclosure without departing from the scope of thesame. While several embodiments of the disclosure have been shown in thedrawings, it is not intended that the disclosure be limited thereto, asit is intended that the disclosure be as broad in scope as the art willallow and that the specification be read likewise. Therefore, the abovedescription should not be construed as limiting, but merely asexemplifications of particular embodiments. Those skilled in the artwill envision other modifications within the scope and spirit of theclaims appended hereto.

What is claimed is:
 1. A system for removal of a tissue specimen from aninternal body cavity, comprising: a cannula arrangement, including: anaccess cannula including a first elongated tubular member defining afirst lumen extending therethrough; a deployment cannula including asecond elongated tubular member defining a second lumen extendingtherethrough and configured for insertion into the first lumen, thesecond elongated tubular member defining a diameter less than a diameterof the first elongate tubular member such that a first annular spacingis defined between the first and second elongated tubular members whenthe second elongated tubular member is inserted into the first lumen; adeployment plunger including a proximal base and a plurality ofengagement arms extending distally from the proximal base, the pluralityof engagement arms configured for insertion through the first annularspace; and an inner cannula including a third elongated tubular memberdefining a third lumen extending therethrough and configured forinsertion into the second lumen, the third elongated tubular memberdefining a diameter less than a diameter of the second elongate tubularmember such that a second annular spacing is defined between the secondand third elongated tubular members when the third elongated tubularmember is inserted into the second lumen; and a containment bagselectively deployable from the cannula arrangement, wherein distaladvancement of the deployment cannula relative to the access cannuladeploys a first portion of the containment bag from the cannulaarrangement, and wherein distal advancement of the deployment plungerrelative to the deployment cannula and the access cannula deploys asecond portion of the containment bag from the cannula arrangement. 2.The system according to claim 1, wherein the first portion of thecontainment bag is disposed within the first lumen.
 3. The systemaccording to claim 1, wherein the second portion of the containment bagis disposed within the first annular space.
 4. The system according toclaim 1, wherein proximal withdrawal and subsequent distal advancementof the inner cannula relative to the deployment cannula and the accesscannula deploys a third portion of the containment bag from the cannulaarrangement.
 5. The system according to claim 4, wherein the thirdportion of the containment bag is disposed within the second annularspace.
 6. The system according to claim 1, wherein, distal advancementof the deployment plunger relative to the deployment cannula and theaccess cannula urges a portion of each of the engagement fingersdistally from the deployment cannula and the access cannula.
 7. Thesystem according to claim 6, wherein, the engagement fingers are biasedtowards a radially-outwardly extending configuration such that, uponextension thereof distally from the deployment cannula and the accesscannula, the engagement fingers extend radially-outwardly.
 8. The systemaccording to claim 6, wherein distal end portions of the engagementfingers are configured for receipt within pockets defined within thecontainment bag.
 9. The system according to claim 1, wherein thedeployment cannula further includes a proximal hub, the proximal hubdefining a central opening communicating with the second lumen, and aplurality of channels radially-spaced from the central opening, theplurality of channels configured to receive the plurality of engagementarms therethrough.
 10. The system according to claim 9, wherein theproximal hub includes a base portion and an insert portion releasablyengagable with the base portion, and wherein the insert portion definesthe central opening therethrough.
 11. The system according to claim 10,wherein the insert portion further defines the plurality of channelstherethrough.
 12. The system according to claim 10, further comprising asecond insert portion configured to releasably engage the base portion,the second insert portion defining a second central opening defining adiameter larger than a diameter of the central opening.
 13. A method ofcontaining a tissue specimen disposed within an internal body cavity,comprising: inserting a cannula arrangement through a vagina and into apelvic cavity, wherein the cannula arrangement includes an accesscannula, a deployment cannula slidably disposed within the accesscannula, a deployment plunger having a plurality of engagement armsslidably disposed within a first annular space defined between theaccess cannula and the deployment cannula, and an inner cannula slidablydisposed within the deployment cannula, and wherein a containment bag isdisposed within the cannula arrangement; distally advancing thedeployment cannula relative to the access cannula to deploy a firstportion of the containment bag from the cannula arrangement, in thepelvic cavity, and at least partially about a tissue specimen; anddistally advancing the deployment plunger relative to the deploymentcannula and the access cannula to deploy a second portion of thecontainment bag from the cannula arrangement and into the pelvic cavitysuch that the containment bag is further disposed about the tissuespecimen.
 14. The method according to claim 13, further comprising:proximally withdrawing the inner cannula from the deployment cannula;and reinserting the inner cannula distally through the deploymentcannula to deploy a third portion of the containment bag from thecannula arrangement and into the pelvic cavity.
 15. The method accordingto claim 13, further comprising withdrawing the first portion of thecontainment bag from the pelvic cavity through an abdominal port. 16.The method according to claim 13, further comprising: inserting atenaculum or a grasper through the inner cannula; and grasping thespecimen with the tenaculum or grasper to maintain the specimen inposition or pull the specimen proximally during deployment of at leastone of the first or second portions of the containment bag.
 17. Themethod according to claim 13, further comprising: proximally withdrawingthe inner cannula; and inserting a morcellator through the deploymentcannula and into the pelvic cavity within the containment bag.
 18. Themethod according to claim 17, wherein an insert portion of thedeployment cannula is replaced with a different insert portion afterproximally withdrawing the inner cannula and before inserting themorcellator.